THE EFFECT OF SPINAL MANIPULATION ON CERVICOGENIC HEADACHES

In this study, researchers set out to determine the effectiveness of spinal manipulation in the treatment of cervicogenic headaches (headaches caused by disorders within the cervical spine). 53 patients were placed into one of two groups which received either,

1 chiropractic spinal manipulation 2X/week for 3 weeks, or,

2 deep friction massage and low-level laser treatments in the upper back and neck region 2X/week for 3 weeks.

After the 6 weeks researchers found that those receiving the chiropractic spinal manipulation:

1 decreased their use of analgesics by 36%, compared with 0% in the no-spinal manipulation group

2 decreased their number of hours they experienced headaches during the day by 69%, compared with 37% in the no-spinal manipulation group

3 decreased their headache intensity per episode by 36%, compared with 17% in the no-spinal manipulation group

A CONTROLLED TRIAL OF CERVICAL MANIPULATION FOR MIGRAINE

The efficacy of cervical manipulation for migraine was evaluated. In a six-month trial, 85 volunteers suffering from migraine were randomly allocated to three treatment groups. One group received cervical manipulation performed by a medical practitioner or by a physiotherapist, another received cervical manipulation performed by a chiropractor, while the control group received mobilization performed by a medical practitioner or by a physiotherapist. For the whole sample, migraine symptoms were significantly reduced. No difference in outcome was found between those who received cervical manipulation, performed by chiropractor or orthodox therapist, and those who received the control treatment. Chiropractic treatment was no more effective than the other two treatments in reducing frequency, duration or induced disability of migraine attacks, but chiropractic patients did report a greater reduction in pain associated with their attacks.

Australian-New Zealand Journal of Medicine 1978; 8:589-593. From the University of New South Wales, Sydney

SPINAL MANIPULATION VS. AMITRIPTYLINE IN CHRONIC TENSION HEADACHES

This randomized controlled trial compared the effectiveness of spinal manipulation and amitriptyline for the treatment of chronic tension-type headache. This study consisted of a 2 week baseline period, a 6 week treatment period and a 4 week post-treatment follow-up period. Of the 150 patients who were enrolled in the study, 24 (16%) dropped out, 5 (6.6%) from the spinal manipulative therapy and 19 (27%) from the amitriptyline group. During the treatment period both groups improved at very similar rates in all primary outcomes.

In relationship to baseline values at four weeks after cessation of treatment, the spinal manipulation group showed:

a 32% reduction in headache intensity,

a 37% reduction in headache frequency,

a 37% reduction in over-the-counter medication usage, and

a 16% improvement in functional health status.

The amitriptyline group showed improvement from baseline values in the same four major outcome measures of 6% or less.

Controlling for baseline differences, all group differences at four weeks after cessation of therapy were considered to be clinically important and were statistically significant. This sustained therapeutic benefit may reduce the need for self-administered analgesic medication. There is a need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare spinal manipulative therapy to an appropriate placebo such as sham manipulation in future clinical trials.

One year after head trauma, 23 patients with post-traumatic headache entered a prospective clinically controlled trial to find out if specific manual therapy on the neck could reduce the headache. The study was completed by 19 patients (83%). Ten patients were treated twice with manual therapy and nine patients were treated twice with cold packs on the neck. The pain index was calculated blindly. Two weeks after the last treatment, the mean pain index was significantly reduced to 43% in the group treated with manual therapy (manipulation) compared with the pre treatment level. At follow-up five weeks later, the pain index was still lower in this group compared with the group treated with cold packs, but this difference was not statistically significant. The pain index for all 19 patients was significantly correlated to the use of analgesics as well as to the frequency of associated symptoms (number of days per week with dizziness, visual disturbances and ear symptoms). It is concluded that the type of manual therapy used in this study seems to have a specific effect in reducing post-traumatic headache. The result supports the hypothesis of a cervical mechanism causing post-traumatic headache and suggests that post-traumatic dizziness, visual disturbances and ear symptoms could be part of a cervical syndrome.

Cephalgia 1990; 10:241-250. From the County Hospital of Aarhus, Denmark.

ANXIETY AND DEPRESSION LINKED TO CHRONIC HEADACHES

According to new research from Ohio University, almost half of chronic tension headache sufferers also suffer from anxiety and depression. In this study, 245 chronic headache sufferers completed questionnaires which assessed their psychological status. Surprisingly, 45% admitted to feeling anxious, depressed or hopeless on almost a daily basis. Researchers were unable to determine whether the psychological problems actually preceded the onset of the headaches.

According to researcher Lipchik, "A lot of people have a difficult time separating 'their headaches from their anxiety and depression' and many of the people don't acknowledge that they have psychological problems or problems managing stress. It's easier for them to discuss it as a consequence of their headaches."

Annual Meeting of the American Association for the Study of Headache. San Francisco, California. 1998.